Health

The Architecture of Abortion Clinics

Instead of being hidden away, what if they were in high schools and on military bases? A new book aims to change the conversation about how the location of clinics plays a critical role in access.

Though abortion and the legal disputes that often surround it are visible media topics, abortion clinics are often pushed to the fringes of communities where access is the most crucial. But what if they were integrated into the mainstream of our everyday space: clinics in malls, clinics on military bases, clinics on high school campuses, and open access to preventative care? Lori Brown explores this topic in her book Contested Spaces: Abortion Clinics, Women’s Shelters and Hospitalsand delves into politics and architecture and how they manufacture landscapes with regard to reproductive healthcare access. As an architect herself, Brown talks below about a more politically engaged discipline of architecture that could positively impact the geography of women’s health. She’ll be speaking about researching abortion clinics on Feb. 26 in New York,but gives us a preview here.

This interview has been edited and condensed.

Women in the World: A lot of your focus is on architecture and the role that it plays in access to abortion clinics. How you found a way that the architecture of a building can actually minimize harassment from protestors

Lori Brown: Sadly what I found out was that architecture—in the sense of what we think about in terms of building—doesn’t seem to factor in. What does seem to factor in is the way clinics create and provide security and even privacy. There were many providers that I spoke to that did many clever things about the sensors and sprinkler systems and with noise. They don’t have a lot of money so they had to think very creatively about ways they could intervene in the space outside their clinic to outsmart the protesters.

I went into this hoping that architecture would play a more significant role. From interviewing all these people there was always this caveat, “Well, we don’t have a lot of money and we can’t afford to work with an architect.” It’s really so unfortunate that up to this point architects have not been involved, even in a pro-bono way, to help these clinics really think about security.

WITW: Tell me about the group you’ve started called Architexx.

LB: I co-started it with Nina Friedman, who is also an architect in NYC and it’s a group of women architects of all ages who want to try and change the discipline. We’re going to run a design competition for the clinic in Mississippi to create an installation on the fence because it’s not very secure and it’s definitely not very private. We want to raise awareness about the role of design and help create a more substantive and secure space for employees and their patients to traverse. We’re calling it a Design Action and it’s going to be in two phases. We want the first phase to be as open to the general public as possible so we’ll present where the site is and we’ll have photographs. And we want people to respond in a postcard format of what they imagine the possibility to be. This could be for designers and non-designers alike. For the second phase, which will happen much later, you have to have a design professional on your team and that will be a more conventional proposal with drawings and renderings. The goal would be to have it built after this whole thing is over.

WITW: In states or places where abortion is a contested issue and women have to travel very far if they want to go to a clinic—what have you found that could reconcile that?

LB: Its interesting that you ask that because one of the clips I'm showing is from The Last Abortion Clinic by Frontline where they met—this was several years ago—with the clinic in Mississippi where one of the directors said, “Women just can’t get to the clinic. They don’t have a car, they can’t afford it, or the timing just doesn’t work.” Especially states where there’s only one clinic it’s a huge issue. You’re not always able to cross the state lines because that neighboring state’s clinic may be just as far in the other direction.

I did come across another case study called The Overground Railroad. It was a group of Quaker women who were inspired by The Underground Railroad. They set up transportation and lodging in order to help women seek abortion in other states if they were in a state where it was really difficult to access. They would provide transportation and lodging and food in between where they lived and the clinic. But it’s not really sustainable. We would need major networks for this to work.

A sociologist mentioned to me that architects need to become a part of local building departments who write code. One of the major issues that has had a lot of success was to make building codes more restrictive for abortion clinics. There’s this whole array of building codes that are requiring massive renovations that clinics can’t afford. One way would be for architects to literally become active in the building code area and help challenge some of these things that make no sense whatsoever.

WITW: Are these restrictions made because they want to shut down these clinics or because they just don’t know the realities of the situation?

I think they’re very clearly meant to shut down clinics and make it more difficult for the clinics to operate. I think they hide under the rhetoric of “Well, it’s going to make it safer for the procedure” but as medical reviews have stated over and over again, this is one of the most safe outpatient procedures that someone can have. These restrictions are targeted to abortion providers whereas other outpatient centers aren’t receiving these same stipulations. So I think it’s very much about trying to shut down and make it far more difficult for abortion clinics to survive. They’re never going to say that, but that’s what’s happening.

WITW: For your book you focused in on abortion clinics in the U.S., Mexico, and Canada, which would have been the most liberal of the three. What worked for them in terms of providing open access to clinics, outside of just having a more liberal government?

LB: It’s interesting in Canada because I had thought their policies are just much more liberal. Their equivalent of Roe v. Wade, R. v. Morgentaler, wasn’t passed until 1988—Roe v. Wade was 1973—but their policies are the most liberal in the world. Because hospitals are most often the place where women will receive reproductive health-care access, it’s far easier because there are hospitals in every community. It’s also a province state. There are provinces where clinics are an access point. For example, in Quebec there’s almost as many clinics as there are hospitals. It’s interesting because space is not as contested in Canada as it is in the U.S. and I think it’s because primarily [abortion] is so integrated in mainstream health care. Whereas in the U.S., it was separated from hospitals and went into clinics, which they originally thought would be safer and cheaper. It did lower the cost but then they became easier targets. One doctor who had several clinics said, “We’re just so far out of the mainstream and that’s a huge problem in terms of access and it just being considered a normative procedure.”

WITW: In Mexico, on the other end of the extreme, what have you found were the challenges in trying to get reproductive services?

LB: Well, they’re incredibly restrictive generally across the country, but Mexico City is the most liberal of all the states. Starting in the 2000s they liberalized the policies, because of who was elected into the government, so they then opened several hospitals that provide abortion that is covered by their health care system. There is a lot of abortion traffic within Mexico at-large that is coming into Mexico City because it is easier to attain. There are a few more states that are not as liberal but a bit more liberal than the general country. It’s still very difficult to access if you live in the rural areas in Mexico.

WITW: Have you done any research focused on women’s shelters?

What if abortion was accessible in high schools? What if it was accessible on military bases, where we know sexual assault is very high. What if it was available in malls because you can’t actually protest in a mall because it’s not public space, it’s private space. There are medical-type facilities already in a mall so why not have an abortion clinic in a mall?

LB: I’ve done some work with shelters and it was a way to compare—where abortion is so publicized, women’s shelters are so privatized. Meaning, it’s very often the policy not to disclose an address of a shelter. It was an interesting contrast to how abortion remains such a publicly debated issues and women’s shelters are hidden within urban and suburban areas.

WITW: Is it an issue for a lot of women that they just don’t have the resources to find the nearest clinic? Or is it just the literal, physical distance that they would have to travel?

LB: I think it’s a bit of both. The physical distance is a huge issue. Statistically it’s women of low economic need that are trying to access these resources. You want to try to get it in an earlier trimester because it’s less expensive then, but there’s all these time delays and waiting periods. If you work and if you need child care… in some cases it becomes prohibitively expensive to be able to physically get there. In other cases it’s not so much getting there physically. In the Midwest, one provider I interviewed was saying that she was getting a lot of patients from a neighboring state because patients weren’t happy with their care [in their state.]

WITW: Are you advocating more local solutions, based in grassroots activism, to alter the geography? Or what are your prescriptions for altering the geography?

LB: I offer provocations because I know what I'm suggesting, within this climate, is not going to happen. I think it’s so much about location and if, bear with me, I suggest that high schools—I know that in New York and California they can provide contraception and even in some schools in New York City they can provide emergency contraception—but what if abortion was accessible in high schools? What if it was accessible on military bases, where we know sexual assault is very high. What if it was available in malls because you can’t actually protest in a mall because it’s not public space, it’s private space. There are medical-type facilities already in a mall so why not have an abortion clinic in a mall? Even one of the case studies I found, which was incredible, it was called the Clergy Consultation Service in New York City, and at one point they were going to open an abortion clinic on the grounds of their church in the West Village. But then the New York State law changed and they didn’t open the clinic but they were going to have an abortion clinic on religious grounds. I just think where we locate these clinics plays a critically important role in how we access them. I know I’ll be shot down for this, but it’s more provocations of locating them in places where the demographic is seeking these services.

WITW: Even though it is very much a publicly debated issue it’s still invisible. You don’t really see any big signs or billboards for abortion clinics. They’re very pushed away and hard to find.

LB: You’re absolutely right. I think there’s also still so much shame around it and culturally we have a long way to go before it’s de-stigmatized.

WITW: Is there any architectural answer to having a more visible and accessible clinic?

LB: One of the other areas that architecture could play a significant role is how security is understood and how security could be creatively incorporated into space. One architect that I’m aware of who works with Planned Parenthood is Anne Fougeron. She’s designed a number of Planned Parenthood clinics which are quite beautiful. She’s done a really good job of incorporating bulletproof materials and nice lighting and nice color-palettes, but with a sense of security. Architects have a skill to be able to think spatially about bringing in security that doesn’t feel like you’re being sequestered or jailed. That came up a lot when I interviewed people. Some people actually had metal detectors that you’d have to walk through. Other people had those wands that you would wave around people. When they first started using these, people were kind of shocked but they’d rather be safe than not. But it sets up a weird feeling. Like, “I'm entering into this space that’s not right or not appropriate.” I think architects would be incredibly useful in terms of having appropriate security in a way that almost can be camouflage, but still be there.